Prediction of outcome in first-episode schizophrenia

Prompt and efficient treatment of acute psychotic episodes combined with the prevention of relapses will limit the accrued morbidity of schizophrenia. However, the heterogeneity of schizophrenia makes it difficult to determine which individuals are most likely to relapse. There are three major potential biological predictors of schizophrenic relapse: (1) behavioral response to dopamine agonist stimulation, (2) the presence of tardive dyskinesia, and (3) increases in anterior pituitary hormones. Dopamine agonists and dopamine antagonist provocative tests, using a single dose of medication, can be used to predict outcome in stabilized schizophrenics undergoing maintenance drug therapy. These tests are indicators of increased dopamine activity, which potentially indicates a worse outcome. This article discusses behavioral response to psychostimulant tests and pituitary hormone levels, particularly growth hormone and prolactin response to dopamine antagonist stimulation. As predictors of outcome, these measures may be useful, clinically, when selecting neuroleptic maintenance schedules, dosage, or withdrawal strategies.